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Now available for preorder:
The San Francisco Panorama.
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[J.B. Orenstein works in the emergency room at Shady Grove Adventist Hospital in Maryland.] - - - - A BAD FLU January 6, 2004 A bad flu season, droningly predicted each year, this year finally is upon us. Bad by virtue of its early, pre-Thanksgiving arrival, bad by deaths in several children thus far, bad by sorry convergence with background fears of SARS, Al Qaeda, and a dreary set of choices for President. SARS has made us a little smarter this year: everyone arriving at the ER gates is given a mask to wear, but the undeniable side effect of advertising the present contagion makes everyone a hair warier. Thus, medical offices and the ER resemble nothing so much as overstuffed shopping malls or gridlocked highways. The onslaught in my own ER started at 11 a.m. on the Friday after Thanksgiving. Normally at that hour our computer tracking-system logs thirty or so patients. That Friday we hit sixty, and the total count hovered from seventy to ninety until midnight, and settled down to about twenty-five through the wee hours. There was a smattering of Chest Pains, Dizzinesses, and Back Pains, but the vast majority came with Fever-Vomiting-Headache-Cough. My first patients Friday night were a mom-n-daughter who, at 9 p.m., had been waiting for three hours to be seen. "Who got sick first?" I asked. "She did," Mom said. "No wait, I did." She shnuffed some snot back into her nose, looking exhausted. "I don't remember anymore." "Did you get a flu shot?" "No. I was worried 'coz I heard it makes you sick. Can I get one now?" "Sorry. We don't give flu shots." The daughter was as droopy as Mom, and cried as soon as she understood I was turning her way to examine her. "S'okay, honey, he's not gonna hurt you. Shh. Relax." Her soothing words failed to comfort the girl, who added her voice to the background wail of the Peds ER, aka the Screamatorium. We battled through an exam: no pneumonia, no ear infection, not really dehydrated either. Just a couple of swollen lymph nodes and a red throat to show for their trouble. Drink tea. Take Tylenol. Motrin. Perhaps needlessly stingy, I stood my ground and withheld the antibiotic prescription they came for, the least pittance of reward for spending several hours among the coughing, sneezing crowds and overworked, harried staff. This scenario reiterated itself endlessly until 6 a.m. Each hour we got a little more caught up, so that by midnight the wait was down to only two hours; by 2 a.m., the sick and feverish only had an hour to wait to be told we had no real remedies for them; and by 5 a.m., we could more or less see them as soon as their names and complaints of fever-cough belched themselves up on the computer tracker. Saturday night was more or less a rerun of Friday night and I was consigned, once again, to Pediatrics. By then, news of flu deaths in Colorado and Texas added an additional note of frenzy and desperation. After the first two or three hours, everybody's story melded together in my head. When I rechecked patients after running labs and X-rays, IV fluids for the dehydrated or breathing treatments for the asthmatics, I began tripping up. To a haggard mom, I reported, "It's flu. Give your daughter tea. Take Tylenol. Motrin. Antibiotics won't help." "Some kids died from the flu." "Yeah. I know." The look she gave me was interesting. Some parents want every test and drug available to provide an absolute reassurance that nothing can or will go wrong. They won't budge from their room until I've either broken down and given them everything they want, or forced me to spend an inordinate amount of time explaining the facts of life. This lady gave me a resigned "if-we're-fucked-we're-fucked" look and didn't press the issue. "I had the flu shot, could I get flu?" "Yeah. They picked wrong this year." Each year the CDC surveys the Far East to predict which strain of flu is likely to break out the following year. They bet on Influenza A-Panama but, wouldn't you know it, we got A-Fujian instead. "Your girl has the same crud virus all these other kids have." "Did you test for flu?" Friday night I had sent off dozens of flu tests. Many were positive, but the flu-negative folks were just as sick and miserable as the flu-positives. Around midnight on Saturday, a lab tech called to give me a heads up: they had only seven flu kits left and weren't getting more until January. "It doesn't pay. If it's not flu, it's one of the other bugs circulating and she'll catch flu later." "Yeah, but there's that new flu antibiotic." Tamiflu. An antiviral, not an antibiotic. It shortens the natural course of the disease by a day or two, and might—might—make it less severe. But it also causes nausea, vomiting, diarrhea, bronchitis, stomach pain, dizziness, headache. Not the kind of additional symptoms you want if you have the flu already. I disgorged this information. Mom shrugged and bundled herself and her daughter up to go home, empty-handed. Sunday night the crush eased up. The waiting times topped out at just over two hours and the simultaneous howling of a dozen sick babies, toddlers, and children seemed a few decibels softer. We cleared out by 5 a.m., unlike the previous two nights, and for an hour or so there were no new kids to be seen. At 4 a.m. the docs, nurses, and techs who felt as though we had seen every last native and visitor in the county felt our hearts lifted when, for the first time in over seventy-two hours, we had to take care of victims from a car wreck. "Can you believe it? It's not flu!" We could have danced for joy. A tired family returning from Pittsburgh spun out and hit a guardrail, and both parents and all three children were more or less unscathed, but we felt positively rejuvenated to be checking necks and backs for injury, sewing small wounds, and considering whether or not to get a CAT scan for the head injury. When I left at 6 a.m., it was for a mere twenty-four-hour break, as the scheduler had thoughtlessly put me on for three early-day shifts after the three overnights. Home hardly proved to be restful. My wife gives flu shots for a company called Passport Health, and all our friends and neighbors started calling once the fear of a bad flu season had been hammered home by the dire news all Thanksgiving-weekend long. Our living room started filling up like the ER's waiting room, and our kitchen became a makeshift clinic for the last-minute vaccine shoppers. Our house cleared by 9 p.m., six hours after I had woken up from a thick, satisfying sleep, and one hour before I planned on going back to bed in order to rest up for the early morning shift. A dry sort of irritation tickled the back of my throat, and I realized that the heavy, dull feeling in my shoulders and back hadn't really gone away either. It was inevitable. The same thing happens each year, only this year I knew which kid it was. A moppet of a four-year-old had been coughing and vomiting, and we needed to do a spinal tap because I was worried she had meningitis (she didn't). This required sedation, cajoling, and holding to get her to stay in just the right position. I spent a good fifteen minutes breathing in the same air she was coughing into, and as we waited for the sedation to kick in, she became quite loopy. "Can I ask you a question?" she whimpered. She repeated this a few times in a benzodiazepine-induced haze. "Can I ask you a question?" "What, sweet pea?" "I love you!" she slurred. "No, you mean you love your mommy." "No, I lo-o-o-ove you." "Thank you, sweet pea. I love you, too." OK, maybe it won't be such a bad flu after all. - - - - PREVIOUS DISPATCHES Three F Us (6/20/03) How Winter Begins in the ER
Swabbing for Spores (11/12/02)
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